This is a first submission for an NHLBI K01 Mentored Career Development Award to Promote Faculty Diversity in Biomedical Research (RFA-HL-12-030) by Nia S. Mitchell, MD, MPH. Dr. Mitchell's overarching career goal is to be a leader in the development and implementation of weight loss programs to underserved populations. Her research proposal uses Take Off Pounds Sensibly (TOPS) as a model for generating new evidence of the effectiveness of community-based programs that provide services to underserved populations. Candidate: Dr. Mitchell is a board-certified internist and an Assistant Professor of Medicine in the Division of General Internal Medicine at the University of Colorado Anschutz Medical Campus. She has completed a Master of Public Health degree and has conducted three database analyses of weight loss programs one of the TOPS program and two of the Weight Watchers program for Tennessee Medicaid recipients. She works closely with her primary mentor, James O. Hill, PhD, with whom she has one article in press and two currently under review. Training: The proposed K01 career development plan builds on prior experience from fellowship and early career development to focus on three areas that require additional training: 1) acquiring skills in geographic information systems (GIS); 2) improving skills in biostatistics, computer modeling, and subgroup analyses; and 3) improving skills in qualitative research methods. Accordingly, Dr. Mitchell proposes intensive topical mentorship, focused coursework, seminars, and contextual learning through the proposed research. These training activities will enable Dr. Mitchell to learn how to rigorously evaluate community-based programs that provide services to underserved populations. Mentors/Environment: Dr. Mitchell and her primary mentor, Dr. Hill, have assembled a strong mentorship team who will guide Dr. Mitchell through the proposed training and research activities. Additionally, Dr. Mitchell is the only underrepresented ethnic minority researcher at the Colorado Health and Wellness Center and she is the only researcher studying weight management interventions for underserved populations, which makes her a valuable asset to the Health and Wellness Center. Research: There is a pressing need to challenge the current paradigm of weight management programs, which has problems with affordability, weight loss maintenance, and implementation especially in low income and minority populations. This study will produce information of direct relevance to those working in clinical practice. Aim 1 will determine the reach of the TOPS program into underserved areas including those with low income and ethnic minority populations, which is essential to understanding the degree to which these populations are accessing the program. This aim will also help categorize chapters for subgroup analyses to determine the features that are associated with the variable effectiveness among chapters. Aim 2 will build upon Dr. Mitchell's prior research to determine the six-year effectiveness of the TOPS program as well as the differential effectiveness among chapters, which will allow Dr. Mitchell to rank chapters based on performance so they can be divided into quintiles and studied quantitatively in Aim 3. Aim 3 will provide a clear conceptual understanding of the implementation of the TOPS program as it discovers the chapter characteristics that influence performance and how these attributes might be modified to raise performance of chapters that serve low income populations to the highest levels. Summary: This project is innovative in several ways. Perhaps the most important way is that it offers a paradigm shift in weight management by applying scientific rigor to utilize the infrastructure of a national nonprofit organization. Instead of designing a new weight loss program with minimal infrastructure for wide- spread dissemination and implementation, it rigorously studies a program that is already present in thousands of communities across the country. This project will allow for a better understanding of the effectiveness of the TOPS program, especially in underserved populations, and allow Dr. Mitchell to maximize future implementation of the program in these populations. Conduct of this mentored research and training proposal, Evaluation of a Low Cost National Weight Loss Program in the Underserved, will facilitate Dr. Mitchell's development into a nationally-recognized independent investigator and leader conducting research that fundamentally changes and improves weight management in low income and minority populations. (End of Abstract)